Psychological and Situational Factors Affecting Dropout from Regular Visits in Diabetes Practice: The Japan Diabetes Outcome Intervention Trial-2 Large Scale Trial 004 (J-DOIT2-LT004)

INTRODUCTION: This study explored the psychological and situational factors affecting dropout from regular visits to diabetes care using data obtained from the Japan Diabetes Outcome Intervention Trial 2 (J-DOIT2) Large-scale Trial (LT). METHODS: A total of 2,031 patients with type 2 diabetes who participated in the J-DOIT2-LT were included in the analysis. Responses to a baseline questionnaire with 17 items asking about the experience of dropout from regular visits in diabetes care and its reasons were analyzed using principal component analysis, and factors related to dropout were extracted. Using Cox regression analysis, the association of these factors with the incidence of dropout was investigated. RESULTS: The mean age of the 2,031 patients was 56.4 ± 5.9 years and 742 (36.5%) were women. They were followed for a median of 392 days, and 125 patients dropped out from regular visits during the follow-up period. In the principal component analysis of the questionnaire, there were four latent factors with eigenvalues of >1.0, which were labeled as “negative perceptions for regular visits,” “social pressure,” “lack of perceived necessity,” and “environmental obstacles” based on the retained items. The Cox regression analysis demonstrated that patients with high scores of “lack of perceived necessity” and “environmental obstacles” had a significantly increased risk of dropout from regular visits. CONCLUSIONS: The present study revealed psychological and situational factors related to dropout, which may be useful for detecting patients at high risk of dropout. Effective measures focusing on such patients to prevent dropouts should be investigated in future studies (The trial registration number: UMIN000002186, registered at the University Hospital Medical Information Network-Clinical Trials Registry).